128.
Treatment algorithms for acute, displaced, midshaft clavicle
fractures in Denmark.
Ilija Ban
of Orthopaedics, Hvidovre University Hospital
Background:
Despite being a frequent injury, the optimal treatment of
clavicle fractures remains debated. As a result of this, variation in treatment
strategies can be expected
Purpose / Aim of Study:
To explore what diagnostic approaches and primary
treatment modalities for acute, displaced, midshaft clavicle fractures are used
in orthopedic departments in Denmark.
Materials and Methods:
A questionnaire was send to 22 orthopaedic
departments in Denmark. The questionnaire addressed the diagnostic
approaches and primary treatment modalities used at the departments. The
surgeon responsible for treatment of clavicle fractures was asked to fill in the
questionnaire. 21 of 22 questionnaires were returned.
Findings / Results:
In 18 of21 cases the department had a valid treatment
guideline for acute clavicle fractures. At 1 department all patients were treated
operatively whereas 6 departments treated patients non-operatively. At the
remaining 14 departments surgery was offered if specific criteria were present.
At 13 of these 14 departments the combination of displacement (> 1 bone
width) and shortening of the clavicle, with or without comminution, were the
indication to offer surgical treatment. A simple sling was preferred at 14 of 21
departments. 2 of 21 departments preferred the figure of 8 bandage. 20 of 21
departments used locking plates. Follow-up regimens after non-operative as
well as operative treatment differed greatly.
Conclusions:
Acute, displaced, midshaft clavicle fractures are predominantly
treated operatively. Shortening of the clavicle, with and without comminution,
is the most used indication to trigger surgical treatment. Supported by
literature findings it could be speculated that these fractures are currently being
overtreated by surgery in Denmark.
